LEILA CHEN
Subscriber on policy B09M000230
Claims
2
Attributed to this person
Charged
1,131.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
153.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | LEILA CHEN |
| Role on the policy | Subscriber |
| Policy | B09M000230 |
| Date of birth | 19 May 1980 |
| Plan | BRONZE EPO |
| Covered from | 12 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 153.00 |
| Total | 153.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000953 | 27 Feb 2025 | 765.00 | CASCADE CARE | Not denied | — |
| CLM0000954 | 29 Oct 2024 | 366.00 | CASCADE CARE | Not denied | — |